Transcription:
Breathe Easy: A Conversation About Kids & Asthma

Bill Klaproth (Host): So, what is asthma? What are the symptoms and how can you tell if it really is asthma? Let’s have a conversation about kids and asthma with Dr. Matthew Bruehl, Pediatric Pulmonologist at WakeMed Children’s. This is WakeMed Voices, a podcast from WakeMed Health and Hospitals. I’m Bill Klaproth. Dr. Bruehl, thank you so much for your time. We appreciate it. So, first off, what is asthma?

Matthew Bruehl, MD (Guest): Excellent question Bill. Asthma has a lot of definitions and all of them are somewhat confusing but how I like to think about it is asthma is reversable small airway obstruction. What that means is that the tiny tubes that take breath from your nose and mouth down into your chest and get smaller and smaller and smaller, once you reach a certain point, we call those small airways and in people with asthma, they don’t behave correctly. They tend to swell. They tend to produce more mucus or snot than they should, and it tends to create a situation where it’s hard to get breath in to where your body tries to fix the problem by coughing to where people experience tightness in their chest and shortness of breath. And these episodes are reversible, so they are recoverable with medications and they occur repeatedly over time.

Host: So, you call this reversible airway obstruction. That’s because this comes and goes, is that right?

Dr. Bruehl: Right. It’s not a permanent state. It’s something that’s in flux that changes depending on the amount of stress or irritation that your body sees. And it can improve with medications or sometimes with just the passage of time.

Host: Very good. So, then we hear this term reactive airway disease. What’s the difference between asthma and reactive airway disease?

Dr. Bruehl: So, because of the difficulty in defining asthma, and there are certain test criteria that we have that require cooperation from the patient or participant; in children who can’t undergo that testing, we give the condition a name that still describes what’s going on but is something different than asthma. That’s where reactive airways disease comes from. It’s a description that the airways are reacting inappropriately which is causing disease or a problem, but people don’t call that asthma. Now there’s an argument to be made that reactive airways disease is just asthma that hasn’t been tested yet. I do think that parents should consider the two terms somewhat interchangeable when they hear healthcare professionals and providers talking about those two terms.

Host: So, when you talk about those two terms, is there a test to determine if it is asthma or not?

Dr. Bruehl: So, there is no one test that says yes or no to asthma, but we have developed methods to describe some of the things we’ve talked about already. One of the tests that is used to inform whether someone has asthma is called spirometry or sometimes lung function testing. What this involves is having the participant breath out very hard and very quickly into a computer which measures the amount of air and the speed of air they are breathing out. And because of some of the mechanical properties of your chest wall and the elastic lung tissue itself, we can use those measurements to determine exactly how blocked the small airways are in a person at any given moment. We can then apply a medication usually albuterol, or a quick acting substance that opens up the small airways by relaxing the muscles surrounding the airways and repeat the test and see if there is a significant difference in both the speed and volume of air that a person is able to breathe out.

Additionally, we can test for certain substances that the body produces when inflamed or stressed and test for their presence in exhaled breath. Otherwise, the tests for asthma really are based on the story or clinical history, physical exam findings that are taken in a doctor’s office and a little bit based on family history and presence of other conditions that are related to asthma such as allergies or skin dryness or eczema.

Host: Really comprehensive answer. Thank you Dr. Bruehl for that. So, as you’re explaining that to us, I’m thinking then what triggers these asthma events if you will? Is it pet dander, mold, pollen? What causes this inflammation if you will in the lungs?

Dr. Bruehl: You hit upon some of the main triggers for asthma that I tend to categorize into environmental triggers. So, things that are in the environment that we breathe in and then also one of the main triggers for childhood asthma are simple colds or viruses or viral infections that tend to hit children with asthma a little harder. They get sick sooner, they stay sick longer, they tend to have more severe symptoms. But you’re right, that triggers for asthma can be anything that we breathe in, that reaches that part of the lungs that we’ve talked about before and initiates that improper response in the small airways, swelling, snot production, clamping down or closing of the airways.

Host: And generally, you mentioned people will start to cough. Is that the body’s way of trying to rid the lungs of this excess fluid buildup? Is that what’s happening?

Dr. Bruehl: That’s part of the reason. So airway irritants and I’m speaking broadly about dust particles, pollen, viruses and other kinds of things that can irritate lungs and people’s bodies in general, themselves trigger a cough reflex as part of the lung’s defense mechanism. You see something coming in, you immediately try and push it out. There are additional mechanisms than cough receptors that attempt to clear out snot or mucus that the chest produces as another part of the defense mechanism. And the cough from asthma is likely a mix of the two. Most people describe it as a dry cough so not productive of snot or sputum but people during exacerbations can have a productive cough or a cough that produces mucus or phlegm from the lungs into the back of the throat.

Host: So, Dr. Bruehl, when it comes to asthma medicines, you’ve mentioned a couple of them, one of them I think you mentioned was albuterol. Are there side effects we should know about of these asthma medicines?

Dr. Bruehl: Yes. So, the main class of medicines used to treat asthma are called corticosteroids. They are related to a substance that your body produces naturally just in different concentrations. The main side effects of inhaled corticosteroid medicines are a little bit of hoarseness, and dry throat that people experience when they first start these medicines. If there is deposition or medicine landing in your mouth, throat and tongue; it can impair your body’s ability to fight back some of the natural organisms we have living in our mouth like molds and certain other types of bacteria. And then one of the long term considerations of children on corticosteroids are the effects on linear growth. What that means is the best information, the best studies we have comparing children who are on these medicines versus those who are not have a very, very slightly decreased rate of growth. The end effect ends up being a difference in potential adult height of about one and a half centimeters or a little less than an inch.

Now what these studies can’t tell us is how being constantly sick and having uncontrolled asthma symptoms affect growth, but we know that chronic illness is also a growth effect. So, most people express hesitation for starting these types of medicines because of the effect on growth and I explore that with families together and try and figure out the best plan for them. As far as other types of medicines used like albuterol, that’s a different class of medicine, a quick acting rescue medicine that acts quickly and is passed through the body pretty quickly. People can experience fast heart rate and a little bit of tremor or jitteriness in their hands when taking that medicine. But the effects are short lived.

Host: Well that’s good to know and I’m sure you get his question all the time. Will my child outgrow asthma?

Dr. Bruehl: So, when someone is diagnosed with asthma, it is a chronic lifelong condition that was present at birth but may have not been manifested and will be with them probably for their entire life. Now, asthma absolutely changes over time. The vast majority of people will experience more mild or less severe symptoms as they get older. Children who have frequent coughing and wheezing spells as infants who are diagnosed with asthma can eventually not experience those symptoms anymore. They may still be a little more sensitive compared to other children around strong odors, perfumes, campfires, car exhaust, things like that. But they won’t require an everyday medicine or even rescue medicine for difficulty breathing.

A certain percentage will persist in their symptom burden until adulthood or later in life. These tend to be people with coexisting conditions like allergies, and eczema but a good percentage of children who are labelled as asthma sometime in their life even though they keep the diagnosis will not have any problems and that’s where you get the perception that people outgrow asthma.

Host: So, good to know most people will manage this successfully into adulthood.

Dr. Bruehl: Correct. Yes, we have many therapies for asthma and a lot of well proven strategies to make sure that people don’t suffer. I want my patients and families with asthma to know that the goal is to do everything that you want to do to not have asthma limit any activities, to not stay home from school, to not need unplanned doctor’s visits, to live a normal life with the help of asthma management from a multidisciplinary team.

Host: Well that’s good to know and I know very comforting for parents to hear. Quick question on lifestyle modifications. Can you improve asthma? Can you build lung function through cardiovascular exercise to decrease asthma attacks? Is that possible?

Dr. Bruehl: Yeah. Yes, so we know that compared with sedentary children, children who get regular cardiovascular activity or exercise tend to have milder symptoms, more reserve and in general, well-conditioned children require fewer asthma treatments and have fewer days with significant asthma symptoms compared with other children. Additionally, excess weight or obesity has a negative effect on asthma symptoms. Children with excess weight and asthma tend to report more days with asthma symptoms in a given year. And generally, more significant asthma symptoms when they do have problems. So, weight control or good nutritional programs to maintain a healthy weight can be a key part of asthma management.

Host: Well that’s important to know too that people do have a certain amount of control in their hands when it comes to managing their asthma.

Dr. Bruehl: Absolutely.

Host: Well, Dr. Bruehl, this has really been extremely informative and fascinating. Thank you so much for your time today. We appreciate it.

Dr. Bruehl: Thank you very much for having me.

Host: That’s Dr. Matthew Bruehl and please visit www.wakemed.org to learn more about WakeMed’s Pediatric specialties and locations. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I’m Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.